Staple trap for surgical stapler

ABSTRACT

An exemplary staple holder of a surgical stapler may include a cavity defined therein, staples held within that cavity; an upper surface; apertures defined through the upper surface through which staples are deployable, at least one wedge movable within the cavity, and at least one staple trap including a strip and arms extending from and bent relative to the strip, where at least one arm resides in a neutral position directly underneath a corresponding aperture.

FIELD OF THE INVENTION

The invention generally relates to a surgical tool and method, and morespecifically to an endocutter.

BACKGROUND

An endocutter is a surgical tool that staples and cuts tissue totransect that tissue while leaving the cut ends hemostatic. Anendocutter is small enough in diameter for use in minimally invasivesurgery, where access to a surgical site is obtained through a trocar,port, or small incision in the body. A linear cutter is a larger versionof an endocutter, and is used to transect portions of thegastrointestinal tract. A typical endocutter receives at its distal enda disposable single-use cartridge with several rows of staples, andincludes an anvil opposed to the cartridge. The surgeon inserts theendocutter through a trocar or other port or incision in the body,orients the end of the endocutter around the tissue to be transected,and compresses the anvil and cartridge together to clamp the tissue.Then, a row or rows of staples are deployed on either side of thetransection line, and a blade is advanced along the transection line todivide the tissue.

During actuation of an endocutter, the cartridge fires all of thestaples that it holds. In known endocutters and linear staplers, wedgesare moved longitudinally, where each wedge sequentially encounters aplurality of staple drivers during its travel. Those staple driversconvert the longitudinal motion of the wedges into vertical motion ofthe staples, driving the staples upward into an anvil. The wedges aresimply solid pieces of metal or other material shaped in a way tofacilitate contact between the wedges and the staple drivers. Dependingon the amount of tissue clamped between a cartridge and an anvil of anendocutter, some of the staples may deploy from the cartridge away fromclamped tissue, such that those staples close but do not close intotissue. Because the staples are made of biocompatible material such asstainless steel or titanium, are small compared to the size of bodilystructures, and are closed or generally closed at the completion ofdeployment, these staples are simply released into the patient, wherethey reside harmlessly just as do the staples that deployed into tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view of an endocutter.

FIG. 2 is a cross-section view of a trocar port positioned in a patient.

FIG. 3 is a perspective view of an exemplary feeder belt.

FIG. 4 is a side view of the feeder belt of FIG. 3.

FIG. 5 is a top view of the feeder belt of FIG. 3.

FIG. 6 is a perspective view of another exemplary feeder belt with tworows of staples frangibly connected thereto.

FIG. 7 is a side view of the feeder belt of FIG. 6.

FIG. 8 is a top view of the feeder belt of FIG. 6.

FIG. 9 is a perspective view of an exemplary end effector of anendocutter that utilizes a feeder belt.

FIG. 10 is a perspective view of the interior of a staple holder of theendocutter of FIG. 9.

FIG. 11 is the perspective view of the interior of a staple holder ofthe endocutter of FIG. 9, with feeder belts shown.

FIG. 12 is a perspective view of a staple holder.

FIG. 13 is a side view of a wedge base.

FIG. 14 is a perspective view of the wedge base of FIG. 13.

FIG. 15 is a perspective view of an active wedge.

FIG. 16 is a side view of a first exemplary wedge plate.

FIG. 17 is an end view of a wedge grate.

FIG. 18 is a side view of a second exemplary wedge plate.

FIG. 19 is a perspective view of the active wedge of FIG. 15 at a firstposition within the staple holder, in a first configuration, showing aknife.

FIG. 20 is a top view of the active wedge of FIG. 15 in the firstposition of FIG. 18.

FIG. 21 is a perspective view of the active wedge of FIG. 15 at thefirst position within the staple holder, in a second configuration.

FIG. 22 is an end cross-section view of the active wedge of FIG. 15 inthe second configuration of FIG. 21.

FIG. 23 is a perspective view of the active wedge of FIG. 15 in a secondposition within the staple holder, in the second configuration.

FIG. 24 is a perspective view of a wedge catch within the staple holder.

FIG. 25 is a perspective view of the active wedge of FIG. 15 in thesecond position within the staple holder, in the first configuration.

FIG. 26 is a perspective view of a blood vessel after transection by anendocutter.

FIG. 27 is a top view of a first exemplary staple trap.

FIG. 28 is a perspective view of the staple trap of FIG. 27.

FIG. 29 is a front view of the staple trap of FIG. 27.

FIG. 30 is a rear view of the staple holder of FIG. 12.

FIG. 31 is a detail side view of the staple trap of FIG. 27 adjacent toa staple of FIG. 7.

FIG. 32 is a detail top view of FIG. 31.

FIG. 33 is a detail top view of FIG. 31 including the aperture throughan upper surface of the staple holder.

FIG. 34 is a perspective view of a second exemplary staple trap.

FIG. 35 is a top view of the staple trap of FIG. 34.

FIG. 36 is a front view of the staple trap of FIG. 34.

FIG. 37 is a perspective view of a third exemplary staple trap.

FIG. 38 is a front view of the staple trap of FIG. 37.

FIG. 39 is a top view of the staple trap of FIG. 37.

FIG. 40 is a top view of a wedge engaging a staple trap.

The use of the same reference symbols in different figures indicatessimilar or identical items.

DETAILED DESCRIPTION Endocutter—Three Staple Rows

Referring to FIG. 1, an endocutter 2 includes an end effector 4 attachedto a shaft 6, which in turn is attached to a handle 8. The end effector4 may be one or more separate components that are connected to the shaft6, or may be fabricated integrally with the distal end of the shaft 6.Referring also to FIG. 2, the end effector 4 and the shaft 6 may besized to pass through a standard trocar port 10 that may be placedthrough tissue 12 of a patient. Advantageously, the end effector 4 maybe sized to pass through a trocar port 10 having an opening between 5-10millimeters in diameter. Alternately, the endocutter 2 may be used inthe course of conventional open surgery, where a trocar port is notused. Alternately, the endocutter 2 may be used in the course ofminimally-invasive surgery, where access to the surgical site in thepatient is gained through a mechanism or structure other than a trocarport, such as the LAP DISC® hand access device of Ethicon Endo-Surgery,Inc., or where access to the surgical site in the patient is gainedthrough an incision or opening in which no port or other mechanism orstructure is placed.

The trocar port 10 may be a hollow generally-tubular structure insertedinto an incision in tissue 12 of a patient to hold that incision openand to prevent damage to the tissue 12 defining the incision openingthat may result from the motion of tools and other objects through theincision. The trocar port 10 may be made from plastic or any othersuitable biocompatible material. The trocar port 10 may have asubstantially circular cross section, a substantially oval crosssection, or any other suitable cross section. The particular dimensionsof a trocar port 10 depend on the particular procedure to be performedon the patient, and may be any suitable dimensions. The trocar port 10may be coupled to a cutting tool (not shown) through its center thatmakes an opening in tissue 12, after which the trocar port 10 is placedinto tissue 12. The cutting tool may be a spike or other cutting orpuncturing device, which is removed from the trocar port 10 when thetrocar port 10 is in position in the chest wall. The combination of atrocar port 10 and a cutting tool is standard in the art.

Referring to FIG. 1, the shaft 6 of the endocutter 2 extends proximallyfrom the end effector 4. The shaft 6 may be flexible or rigid. The shaft6 may be articulated in at least one location, if desired. Optionally,the shaft 6 may include a cutaway, trough or other feature (not shown)to allow a guidewire (if any) or other positioning aid that may be usedin the surgical procedure to remain in place during actuation of theendocutter 2.

The handle 8 may be attached to the proximal end of the shaft 6, or anyother suitable portion of the shaft 6. The shaft 6 may be fabricatedintegrally with the handle 8. Alternately, the shaft 6 and the handle 8may be two separate items that are connected together in any suitablemanner. The handle 8 may include any mechanism, mechanisms, structure orstructures that are suitably configured to actuate the end effector 4.The handle 8 may also include a source of stored energy for actuatingthe end effector 4. The source of stored energy may be mechanical (suchas a spring), electrical (such as a battery), pneumatic (such as acylinder of pressurized gas) or any other suitable source of storedenergy. The source of stored energy, its regulation, and its use inactuating the end effector 4 may be as described in the U.S. patentapplication Ser. No. 11/054,265, filed on Feb. 9, 2005, which is hereinincorporated by reference in its entirety. The handle 8 may instead, oralso, include a connector or connectors suitable for receiving storedenergy from an external source, such as a hose connected to a hospitalutility source of pressurized gas or of vacuum, or an electrical cordconnectable to a power source.

Referring to FIGS. 3-5, a portion of a feeder belt 16 is positionedwithin the end effector 4. The feeder belt 16 may be a long, narrow,thin strip of material from which one or more staples 18 extend. Thefeeder belt 16 may be fabricated from stainless steel, nickel-titaniumalloy, or any other suitable metallic or non-metallic material. Thefeeder belt 16 is flexible enough, and strong enough, to be advancedlinearly and then redirected around a nose or other structure insubstantially the opposite direction, as described in greater detailbelow. Alternately, the feeder belt 16 may be rigid or at leastpartially rigid, and may be advanced or retracted substantially linearlywithout redirection about a structure.

Two rows 26 of staples 18 may extend from the feeder belt 16. With sucha feeder belt 16, one row 26 of staples 18 may be located along eachside of the feeder belt 16. At least two staples 18 in different rows 26may be staggered relative to one another. That is, at a givenlongitudinal position along the feeder belt 16 at which a staple 18 inone row 26 is attached to the feeder belt 16, the other row 26 does nothave a staple 18 attached to the feeder belt 16. This staggering of thestaples 18 promotes hemostasis in tissue treated with the end effector4. Alternately, staples 18 in each row 26 may be aligned with oneanother, such that at a given longitudinal position along the feederbelt 16 at which a staple 18 in one row 26 is connected to the feederbelt 16, each other row 26 has a staple 18 connected to the feeder belt16 as well.

The staples 18 in each row 26 may be substantially evenly spaced apartfrom one another. That is, the distance between any twolongitudinally-adjacent staples 18 in a row is substantially the same.Alternately, at least two longitudinally-adjacent staples 18 in each row26 may be spaced apart a distance different from the distance betweentwo other longitudinally-adjacent staples 18. Such a configuration maybe useful where the length of the staple line is not adjustable. Thestaple line to be created with the end effector 4 may be fixed at aparticular number of staples 18, and the staples 18 in each row may begrouped together in groups each having a length substantially the sameas that fixed staple line. Each group of staples 18 in a row 26 may thusbe separated from the adjacent group of staples 18 by a blank space onthe feeder belt 16, where that blank space may have any suitable length.

Each staple 18 may be shaped in any suitable manner; the staples 18 maybe shaped substantially the same as one another, or may be shapeddifferently. As one example, each staple 18 is generally V-shaped, andhas two legs 20 extending from the base of the V-shape. The base of theV-shape of the staple 18 may be curved, pointed or otherwise configured.One leg 20 of the staple 18 may be generally straight, and the other leg20 of the staple 18 may be gently curved. However, the legs 20 may beshaped in a different manner. For example, both legs 20 may be curved.Further, each leg 20 may be shaped in the same manner. The staple 18need not be symmetrical, but can be fabricated symmetrically if desired.

As another example, referring also to FIGS. 6-8, at least one staple 18may be shaped as a continuous curve, as may be most clearly seen in FIG.26. A distal end of the staple 18 may be connected to the feeder belt16, such as via a tab 28 protruding laterally from the feeder belt 16,such as described above. However, as used in this document, the term“tab” encompasses any frangible connection between the staple 18 and thefeeder belt 16. Further, as used in this document, the terms “frangible”and “frangibly” have their ordinary meaning, which is “breakable.” Thestaple 18 may extend proximally and downward from the tab 28. Then, thestaple 18 may continue to curve downward, but also curve distally toform a bump 19. This bump 19 may extend to the longitudinal position ofthe tab 28, further distally than the longitudinal position of the tab28, or not as far longitudinally as the tab 28. Then, the staple 18 maycontinue to curve downward, but also curve proximally. The staple 18continues to curve proximally, then begins to curve upward at aninflection point 21. The staple 18 then continues to curve upward andproximally until terminating at a free end 22 at its proximal end.

One leg 20 of the staple 18 has a free end 22 that may be characterizedas a tissue penetrating tip 22. The tissue penetrating tip 22 may besharpened, if desired, to facilitate penetration of tissue. However, thelegs 20 of the staple 18 may have a cross-section that is small enoughthat the tissue penetrating tip 22 need not be sharpened in order toeasily penetrate tissue. The other leg 20 is attached at one end to thefeeder belt 16. Advantageously, that leg 20 is frangibly connected tothe feeder belt 16. Thus, one end of the staple 18 may be affixed to thefeeder belt 16 and the other end of the staple 18 may be free.Alternately, the staple 18 may have three or more legs 20, or may beshaped in any other suitable manner.

The feeder belt 16 and staples 18 may be fabricated in any suitablemanner. As one example, a flat, thin sheet of material is laser cut intolong strips, after which each strip is laser cut to form fingers thereinthat are then bent into the shape of the staples 18. In this way, thestaples 18 and the feeder belt 16 form an integral structure. However,the feeder belt 16 and staples 18 may be fabricated in any othersuitable manner. As one example, the staples 18 and feeder belt arefabricated separately, and the staples 18 are then connected to thefeeder belt 16 by welding, adhesive, or any other method that provides afrangible connection between the staples 18 and the feeder belt 16.

A frangible connection between the feeder belt 16 and each correspondingstaple 18 may be configured in any suitable manner. As one example,referring particularly to FIG. 5, each feeder belt 16 may include atleast one tab 28 protruding laterally therefrom, or defined laterally inthe center thereof. Alternately, at least one tab 28 may be orienteddifferently. Advantageously, the tabs 28 result from laser cutting andsubsequent mechanical deformation of the staples 18 duringmanufacturing, such that the tabs 28 and staples 18 are integral withthe corresponding feeder belt 16. However, the tabs 28 and/or staples 18may be fabricated and connected to the feeder belt 16 in any othersuitable manner. At least one staple 18 may be attached to acorresponding tab 28 in any suitable manner. The attachment between astaple 18 and the corresponding tab 28 may be made in any suitablemanner, and the connection between a staple 18 and the corresponding tab28 may have any suitable orientation. As one example, at least one tab28 is generally rectangular, and the corresponding staple 18 extendsfrom the proximal edge of that rectangular tab 28. The staple 18 may beseparable from the tab 28, at a location generally at the intersectionbetween the staple 18 and the tab 28. The connection between a staple 18and the corresponding tab 28 is strong enough to hold the staple 18securely in place relative to the feeder belt 16 prior to deployment,and weak enough to be broken or otherwise separated from the tab 28during or after deployment. Optionally, a staple 18 and/or tab 28 mayinclude a weakened area at or near their intersection, in order tofacilitate separation between the staple 18 and the feeder belt 16during or after deployment. The weakened area may have a reducedcross-sectional area, may be notched, or otherwise structurallyweakened. Alternately, the weakened area may also, or instead, bephysically treated or otherwise configured to be weaker than thesurrounding material, while having substantially the same physicaldimensions as that surrounding material.

As shown in FIGS. 3-5, the staples 18 are in an initial configurationprior to being deployed. In the initial configuration, the staples 18 donot substantially contact one another. Alternately, at least two of thestaples 18 may contact one another in the initial configuration. Thestaples 18 each may lie substantially in a single plane. That is, thestaple 18 may be shaped such that a single plane extends through andsubstantially bisects the staple 18. Alternately, at least one staple 18does not lie substantially in a single plane. At least one staple 18 maybe positioned in a plane that is generally perpendicular to the feederbelt 16. Alternately, at least one staple 18 may be positioned in aplane that is angled differently relative to the feeder belt 16. One ormore rows 26 of staples 18 are connected to the feeder belt 16. Each row26 of staples 18 is the group of staples 18 positioned at substantiallythe same lateral location relative to the longitudinal centerline of thefeeder belt 16, and each row 26 of staples 18 is oriented generallylongitudinally. The feeder belt 16 may form a continuous loop, or mayhave a discrete beginning and end that are not attached to one another.Alternately, more or fewer rows 26 of staples 18 may be attached to thefeeder belt 16. Each row 26 may extend along part, or all, or the lengthof the feeder belt 16. Different rows 26 may extend different lengthsalong the feeder belt 16.

Staples 18 in two or more different rows 26 along a single feeder belt16 may be arranged in any suitable manner relative to one another. Asone example, staples 18 in two or more different rows 26 along a singlefeeder belt 16 may be staggered relative to one another. That is, at agiven longitudinal position along a single feeder belt 16 at which astaple 18 in one row 26 is attached to the feeder belt 16, at least oneother row 26 does not have a staple 18 attached to that feeder belt 16.This staggering of the staples 18 promotes hemostasis in tissue treatedwith the end effector 4. Alternately, staples 18 in two or more of therows 26 along a single feeder belt 16 may be aligned with one another,along at least part of the length of the rows 26, such that at a givenlongitudinal position along the feeder belt 16 at which a staple 18 inone row 26 is attached to the feeder belt 16, each other row 26 has astaple 18 attached to the feeder belt 16 as well. Alternately, staples18 in two or more rows 26 along a single feeder belt 16 may be arrangeddifferently along different longitudinal portions of that feeder belt16. Staples 18 may be arranged relative to one another in the samemanner, or differently, on different feeder belts 16 of the endocutter2.

The staples 18 in each row 26 may be substantially evenly spaced apartfrom one another. That is, the distance between any twolongitudinally-adjacent staples 18 in a row may be substantially thesame. Alternately, at least two longitudinally-adjacent staples 18 ineach row 26 may be spaced apart a distance different from the distancebetween two other longitudinally-adjacent staples 18. Such aconfiguration may be useful where the length of the staple line is notadjustable. The staple line to be created with the end effector 4 may befixed at a particular number of staples 18, and consequently the staples18 in each row may be grouped together in groups each having a lengthsubstantially the same as that fixed staple line. If so, each group ofstaples 18 in a row 26 may be separated from a adjacent group of staples18 by a blank space on the feeder belt 16, where that blank space mayhave any suitable length. Advantageously, no staples 18 extend from, orinto an area bounded by, the blank space of the feeder belt 16.

Referring also to FIG. 9, the end effector 4 may include a staple holder30 and an anvil 32. The anvil 32 may be movable about a pin 34 of otherstructure relative to the staple holder 30 to clamp and/or compresstissue therebetween in any suitable manner. The anvil 32 may includestandard staple bending features defined therein to facilitate closureof the staples 18. Alternately, staple bending features may be omittedfrom the anvil 32. The anvil 32 may be pivotable relative to the stapleholder 30. In this way, the distal end of the anvil 32 may be spacedapart from and positioned above the staple holder 30 in a first, initialposition prior to clamping tissue, while the proximal end of the anvil32 may be connected to the staple holder 30. Clamping of tissue bybetween the staple holder 30 and the anvil 32 may be performed in anysuitable manner, and example of which is set forth in U.S. patentapplication Ser. No. 12/612,614, filed on Nov. 4, 2009, which is hereinincorporated by reference in its entirety. Alternately, the anvil 32 maybe connected to and/or movable relative to the staple holder in adifferent manner. Alternately, the staple holder 30 may be movablerelative to the anvil 32. Alternately, the staple holder 30 and theanvil 32 may be movable relative to one another. The distal end of thestaple holder 30 and the distal end of the anvil 32 may be blunt, inorder to prevent inadvertent engagement of tissue with the end effector4 during insertion of the end effector 4 into the patient and motion ofthe end effector 4 to a treatment site. Advantageously, the stapleholder 30 is fixed to a remainder of the end effector 4 and/or the shaft6, and is not detachable therefrom. As set forth in greater detailbelow, the staple holder 30 may be fired multiple times without beingwithdrawn from the patient, such that there is no need to withdraw theend effector 4 from the patient after each firing of staples 18 in orderto replace a staple cartridge or other component. Nevertheless, ifdesired the staple holder 30 may be detachable from a remainder of theend effector 4 and/or the shaft 6; the end effector 4 may be detachablefrom the shaft 6; and/or the shaft 6 may be detachable from the handle8.

The staple holder 30 may include any suitable components. Referring alsoto FIG. 10, the staple holder 30 may include a feeder belt guide 40. Thefeeder belt guide 40 may be configured in any suitable manner. Thefeeder belt guide 40 may be located in proximity to the distal end ofthe staple holder 30. The feeder belt guide 40 may include one or morereversal wheels 42 that rotate about a reversal axle 44. Optionally, oneor more reversal wheels 42 may include teeth 46 that engagecorresponding apertures 51 in a feeder belt 16, as described in greaterdetail below. The reversal axle 44 may be held in place via fixation toa lateral part of the staple holder 30, which is omitted from FIG. 7 forclarity. The bottom inner surface 49 of the staple holder 30 may includeone or more generally-longitudinal channels 48 defined therein. A step50 may be defined on the lateral side of one or more channels 48, andmay extend along some or all of the length of each channel 50. Each step50 may be located slightly above and generally parallel to the lowersurface of the corresponding channel 48. As another example of feederbelt guide 40, a feeder belt guide may be used as described incommonly-assigned U.S. Pat. App. Publication No. 2009/0065552 of Knodelet. al., published on Mar. 12, 2009, (the “Endocutter Document”), whichis herein incorporated by reference in its entirety.

As used in this document, the term “upper” and similar terms oforientation mean a direction that is both perpendicular to thelongitudinal centerline of the staple holder 30 and oriented toward theanvil 32. The term “lower” and similar terms of orientation refer to thedirection opposite to the “upper” direction defined immediately above.The terms “distal” and “proximal” are used in the same manner as isstandard to those of ordinary skill in the art, and refer to oppositedirections along the longitudinal centerline of the staple holder 30, asillustrated in FIG. 10. The distal direction is oriented toward the freeend of the staple holder 30, and the proximal direction is opposite tothe distal direction.

Referring also to FIG. 11, the end effector 4 may include one or morefeeder belts 16. In this way, staples 18 can be deployed on either sideof an incision or transection to be made in tissue. Alternately, the endeffector 4 may include only one feeder belt 16, or three or more feederbelts 16. The feeder belts 16 may be independent of one another, orconnected to one another in any suitable manner. A feeder belt 16 may berouted around each reversal wheel 42. If provided, teeth 46 in one ormore reversal wheels 42 may engage apertures 50 in a correspondingfeeder belt or belts 16. Each feeder belt 16 may be routed along a paththat starts generally straight and in the distal direction, then iscurved along the surface of the corresponding reversal wheel 42, andthen is generally straight and in the proximal direction. That is, thereversal wheel 42 changes the direction of motion of the correspondingfeeder belt 16 from generally distal to generally proximal.

The feeder belts 16 need not each contain the same number of staples 18.Referring to FIG. 12, a plurality of apertures 62 may be defined throughthe upper surface 60 of the staple holder 30, where the apertures 62allow for deployment of staples 18 through the upper surface 60. Theapertures 62 may be arranged into one or more longitudinally-orientedrows. As seen in FIG. 9, six longitudinally-oriented rows of apertures62 may be provided. A knife slot 64 may be defined through the uppersurface 60 of the staple holder 30 as well to allow for passage of aknife, as described in greater detail below. The rows of apertures 62may be arranged symmetrically about the knife slot 64 as seen in FIG. 9,where three rows of apertures 62 are provided on each side of the knifeslot 64. However, the apertures 62 may be arranged asymmetrically orotherwise arranged about the knife slot 64. Where three rows ofapertures 62 are present on each side of the knife slot 64, two feederbelts 16 may be utilized, as seen in FIG. 11. If so, staples 18 mayextend at an angle from each of two lateral edges of one feeder belt 16a, and staples 18 may extend at an angle from only one lateral edge ofan adjacent feeder belt 16 b. As another example, two identical feederbelts 16 may be provided, each of which includes staples 18 that extendat an angle from each of two lateral edges of the feeder belt 16, butstaples 18 are only deployed from both lateral edges of one feeder belt16; staples 18 are only deployed from one edge of the other feeder belt16. An advantage of doing so is simplicity of manufacture, in that themanufacturer only need stock and track one type of feeder belt 16,rather than two separate feeder belts 16 each having a different numberof staples 18.

Referring to FIGS. 13-14, a wedge base 70 forms part of an active wedge,as described in greater detail below. The wedge base 70 includes one ormore bulkheads 72. Referring also to FIG. 22, each bulkhead 72 is sizedto fit underneath a corresponding feeder belt 16. Each bulkhead 72 has awidth generally similar to the width of the corresponding feeder belt16. In this way, each bulkhead 72 has a width that allows the bulkhead72 to slide longitudinally along a corresponding feeder belt 16 betweenthe staples 18 affixed to the feeder belt 16. Referring back to FIGS.13-14, as one example, the bulkheads 72 may be arranged into two groupsof two, where each group is laterally spaced from the other a distancegreater than the distance between the bulkheads 72 in a single group.Each bulkhead 72 may have an upper surface 74. The upper surface 74 maycontact, or be spaced apart vertically from, the corresponding feederbelt 16. Each bulkhead 72 may have a lower surface 76. The lower surface76 may be generally parallel to the upper surface 74. Alternately, thelower surface 76 may be shaped and/or oriented in a different manner.Each bulkhead 72 may have a front surface 78, which may take anysuitable shape. As one example, the front surface 78 may be angledupward in the proximal direction. Similarly, each bulkhead 72 may have arear surface 80, which may take any suitable shape. As one example, therear surface 80 may be angled downward in the proximal direction.

A channel 82 may be defined in each lateral side of each bulkhead 72.The channels 82 allow for motion of a wedge grate relative to the wedgebase 70, as described in greater detail below. The channel 82 may haveany suitable shape. As one example, the distal end 84 of the channel 82is also the lowest end of the channel 82. The channel 82 may include acentral segment 86 that is angled upward in the proximal direction fromthe distal end 84. The distal end 84 may extend a short distance distalto the distal end of the central segment 86, and that distal end 84 mayextend generally longitudinally. In this way, the central segment 86 isangled relative to the distal end 84. At the upper, proximal end of thecentral segment 86, a detent 88 may be positioned. That is, the channel82 defines a detent at its most proximal location. The detent 88 mayextend a short distance proximal to the proximal end of the centralsegment 86, generally longitudinally. Above the detent 88, the upper endof the channel 82 may include an insertion aperture 89.

The wedge base 70 may include a boss 90. The boss 90 may be located ator near the proximal end of the wedge base 70, generally along thelongitudinal centerline thereof. Alternately, the boss 90 may be locatedat any suitable position on the wedge base 70. The boss 90 may bepositioned proximal to the bulkheads 72, or may be positioneddifferently relative to the bulkheads 72. Optionally, the wedge base 70may include a knife mount 92. The knife mount 92 to be located at ornear the distal end of the wedge base 70, generally along thelongitudinal centerline thereof. Alternately the knife mount 92 may belocated at any suitable position on the wedge base 70. The knife mount92 be positioned distal to the bulkheads 72, or may be positioneddifferently relative to the bulkheads 72. The wedge base 70 may includeone or more return arms 94. Each return arm 94 may be oriented generallylongitudinally, and may be cantilevered proximally from a part of thelower surface 76 of the wedge base 70. In this way, the proximal end ofthe return arm is movable vertically at its proximal end. At theproximal end of the return arm 94, a tooth 96 extends downward. Theproximal face of the tooth 96 may be a substantially vertical plane 98,and the distal face of the tooth 96 may be a substantially planarsurface 99 angled downward in the proximal direction.

Referring also to FIG. 15, an actuation band 100 is connected to theboss 90. Advantageously, the actuation band 100 is fixed to the boss 90in any suitable manner. Alternately the actuation band 100 may beremovable from the boss 90. The actuation band 100 may have any suitableshape, and may be fabricated from any suitable material, such as but notlimited to stainless steel. As one example, the actuation band 100 maybe generally rectangular in cross-section, where the lateral width ofthe actuation band 100 spans a lesser distance than the vertical heightof the actuation band 100. In this way, the actuation band 100 may havesome lateral flexibility to allow it to pass through an articulation inthe shaft 6, while still providing vertical stiffness. The actuationband 100 is axially stiff enough for it to both push the wedge base 70distally and pull the wedge base 70 proximally. The actuation band 100may extend from the wedge base 70 through the entirety of the shaft 6into the handle 8.

Referring also to FIGS. 16-17, at least one wedge grate 110 is movablyconnected to the wedge base 70. Each wedge grate 110 includes at leastone wedge plate 112. The wedge plates 112 may be substantially planar,and substantially parallel to one another within the same wedge grate110. A cross pin 114 may connect the distal ends of the different wedgeplates 112 of the wedge grate 110. The cross pin 114 may be generallycylindrical. The cross pin 114 may have any other suitable shape; forexample, a rectangular or triangular solid. As described in greaterdetail below, at least one wedge plate 112 sequentially contacts staples18 along a longitudinal row along a feeder belt 16, first deforming astaple 18 and then breaking that staple 18 from the feeder belt 16. Eachwedge plate 112 may have any suitable shape. As one example, referringto FIG. 16, a wedge plate 112 may include an encounter surface 116, adeformation surface 118, and a separation surface 120. The encountersurface 116 may be substantially vertical. Proximal to the encountersurface 116, the deformation surface 118 may extend upward in theproximal direction, where the deformation surface 118 is substantially astraight line. The surfaces 116, 118 may be immediately adjacent to oneanother, or maybe longitudinally separated any suitable distance.Proximal to the deformation surface 118, the separation surface 120 mayextend further upward in the proximal direction. The surfaces 118, 120may be immediately adjacent to one another, or maybe longitudinallyseparated any suitable distance. As another example, referring to FIG.17, the encounter surface 116 may extend vertically a shorter lengththan the encounter surface 116 of FIG. 16. The deformation surface 118may be smoothly curved, and may be a convex surface. As another example,each wedge plate 112 may have any other suitable shape. The wedge plates112 in a single wedge grate 110 may all have substantially the sameshape. Alternately, at least one wedge plate 112 within a wedge grate110 they be shaped differently than at least one other wedge plate 112.

Each wedge plate 112 has at least one pin 122 extending therefrom. Eachpin 122 is received in a corresponding channel 82 in the wedge base 70.During assembly, the pins 122 may be inserted into the correspondinginsertion apertures 89 of the channels 82. Advantageously, each bulkhead72 of the wedge base 70 includes channels 82 on both lateral sidesthereof. Wedge plates 112 may be positioned lateral to each lateral sideof each bulkhead 72. The term “active wedge” is defined to mean thecombination of the wedge base 70 with at least one wedge grate 110movably connected thereto. Referring to FIG. 15, where two groups of twobulkheads 72 are utilized, two wedge grates 110 may be utilized, whereeach wedge grate 110 is associated with a corresponding group of twobulkheads 72. One wedge plate 112 may be positioned laterally inwardfrom the innermost lateral side of the innermost bulkhead 72; anotherwedge plate 112 may be positioned between the bulkheads 72 in the samegroup, and the third wedge plate 112 may be positioned laterally outwardfrom the outermost lateral side of the outermost bulkhead 72.

Referring to FIGS. 14 and 19, a knife 124 may be connected to the knifemount 92 of the wedge base 70, or to any other suitable portion of thewedge base 70. The knife 124 may have a sharp edge 126 that issubstantially vertical and that is at the distal edge of the knife 124.Alternately, the sharp edge 126 may be shaped and/or orienteddifferently. Optionally, an I-beam head 128 may be positioned at the topof the knife 124, or at any other suitable location on the knife 124.The I-beam head 128 may be received in a corresponding cavity within theanvil 32, and may slide along that cavity to facilitate clamping.

A proximal wedge catch 130 may be fastened to the bottom inner surface49 of the staple holder 30. The proximal wedge catch 130 may be a wireor wire spring that slopes upward in the proximal direction to a peak132, then slopes downward to a proximal end that is lower than the peak132. The proximal wedge catch 130 may be generally U-shaped, or maydefine a closed perimeter. The distal end of the proximal wedge catch130 may be held in a notch 133 in the bottom inner surface 49 of thestaple holder 30. Referring also to FIG. 24, distal to the proximalwedge catch 130, in proximity to the distal end of the staple holder 30,a distal wedge catch 134 may be fastened to the bottom inner surface 49of the staple holder 30. The distal wedge catch may be a wire or wirespring that slopes upward in the distal direction to a peak 136, thenslopes downward to a distal end 138 that is lower than the peak 136. Thedistal wedge catch 134 may be generally U-shaped, or may define a closedperimeter. The proximal end of the distal wedge catch 134 may be held ina notch 139 in the bottom inner surface 49 of the staple holder 30.

Staple Trap

FIGS. 27-29 show an exemplary staple trap 200 may be utilized in thestaple holder 30. The staple trap 200 may be utilized whether an activewedge 71 or a conventional wedge is used to deploy the staples 18. Thestaple trap 200 may include a strip 202 that may be a long, rectangularpiece that may be substantially thinner than it is high or long, as seenmost clearly in FIG. 28. In this way, the strip 202 may be considered todefine or lie in a plane, where that plane bisects the thinnestdimension of the strip 202. The strip 202 may be rigid, or may beflexible. If the strip 202 is flexible, it may be held rigid by contactbetween the strip 202 and the staple holder 30, or in any other suitablemanner. The strip 202 may be a portion of the staple trap 200 spacedlongitudinally apart from the distal and/or proximal end of the stapletrap 200. The strip 202 may be shorter in height in the verticaldirection than a portion of the staple trap 200 located distal and/orproximal to the strip 202. One or more fingers 206 may extend upwardfrom the strip 202. At least one finger 206 may be generally rectangularin shape as viewed from the side. Alternately, one or more fingers 206may be shaped differently or extend in a different direction from thestrip 202. An arm 204 may extend generally in the proximal directionfrom each finger 206. Alternately, at least one arm 204 may extendgenerally in the distal direction, or any other suitable direction, fromthe corresponding finger 206. At least one arm 204 may extend directlyfrom the strip 202 or from a part of the staple trap 200 other than thestrip 202.

At least one arm 204 may be curved at least partially out of the planedefined by the strip 202. This curvature may be smooth, or may bedefined by a number of straight lines that collectively approximate asmooth curve. Referring to FIGS. 27 and 29, an example of curvature isshown. The arm 204 may extend proximally from a corresponding finger206. Moving in the proximal direction, the arm 204 may curve in a firstlateral direction relative to the plane of the strip 202. The curvaturemay continue to a peak 208 that is the point having the furthestdistance laterally from the strip 202. Moving in the proximal directionfrom the peak 208, the curvature of the arm 204 may then continue in theopposite direction. The arm 204 may cross the plane of the strip 202,such that its proximal end 210 is located on the other lateral side ofthe strip 202 from the peak 208 of the arm 204. Alternately, theproximal end 210 of the arm 204 may be located on the same side of thestrip 202 as the peak 208.

The staple trap 200 may be fabricated from any suitable material, in anysuitable manner. As one example, the staple trap 200 may be fabricatedfrom stainless steel. As another example, the arms 204 and strip 202 maybe fabricated by stamping, laser cutting, or any other suitablemanufacturing method.

Referring to FIGS. 10 and 30, the channels 48 in the staple holder 30may be a lower section of a cavity 212 defined generally longitudinallyin the staple holder 30. The staple holder 30 may contain two cavities212, or any other suitable number. Each cavity may include two lateralwalls 214 and an upper surface 216. Advantageously, against each lateralwall 214 a staple trap 200 is positioned. Each staple trap 200 may beheld against the corresponding lateral wall 214, affixed to thecorresponding lateral wall 214, or in any suitable way positionedagainst the corresponding lateral wall 214.

A feeder belt 16 may be positioned against or in proximity to the uppersurface 216 of the cavity 212, with the staples 18 positioned againstthe staple traps 200. The arms 204 of each staple trap 200 may bepositioned in any suitable manner relative to the staples 18 of thecorresponding staple trap 200. As one example, referring to FIGS. 7 and27-29, in an initial pre-firing configuration each arm 204 of the stapletrap 200 is in a neutral position. The “neutral position” of each arm204 is the position the arm 204 assumes when substantially free from theaction of externally applied forces. Referring also to FIGS. 31-33, whenan arm 204 is in the neutral position, the peak 208 of that arm 204 maybe located between the legs 20 of the staple 18 and above the inflectionpoint 21. The peak 208 may extend laterally outward further than thestaple 18 itself, as seen in FIG. 32, but need not do so. As seen inFIG. 33, in the neutral position the arm 204 is directly underneath acorresponding aperture 62 defined through the upper surface 60 of thestaple holder 30. In order to deploy the staple 18 through the aperture62, the arm 204 moves out of the way, as described in greater detailbelow. As another example, in an initial pre-firing configuration, atleast one staple 18 is positioned adjacent to and in contact with acorresponding arm 204, such that at least one staple 18 contacts anddeflects the corresponding arm 204 laterally out of the neutral positionin the initial, pre-firing configuration. If so, each such arm 204 maybe in a position that is not directly underneath the correspondingaperture defined through the upper surface 60 of the staple holder 30.

Referring to FIGS. 34-36, another exemplary staple trap 200 is shown.The staple trap 200 and strip 202 may be configured substantially asdescribed above. However, in FIGS. 34-36 the fingers 206 are omitted,and the arms 204 extend directly from the strip 202. Each arm 204 may besubstantially a parallelogram, where each parallelogram is curvedlaterally toward the distalmost, uppermost corner of each arm.Alternately, each arm 204 may be substantially triangular in shape. Thelateralmost corner of each arm 204 may be referred to as the peak 208 ofthat arm 204. This staple trap 200 may be positioned in the stapleholder 30 in substantially the same manner as described above.

Referring to FIGS. 37-39, another exemplary staple trap 200 is shown.The staple trap 200 and strip 202 may be configured substantially asdescribed above. However, in FIGS. 37-39 the fingers 206 are omitted,and the arms 204 extend directly from the strip 202. Each arm 204 may besubstantially a trapezoid, where each trapezoid is curved laterallytoward the distalmost, uppermost corner of each arm. The lateralmostcorner of each arm 204 may be referred to as the peak 208 of that arm204. This staple trap 200 may be positioned in the staple holder 30 insubstantially the same manner as described above.

Operation

Referring to FIG. 2, at least one trocar port 10 may be inserted into anopening in tissue 12 of a patient 14. Where a trocar port 10 includes acutting tool (not shown) such as a spike, that cutting tool makes anopening in tissue 12, after which the trocar port 12 is placed intissue. The cutting tool may be removed from the trocar port 10 afterthe trocar port 10 is in position in tissue 12. Alternately, an openingin tissue 12 may be made first with a separate tool, and the trocar port10 is then placed in that opening. Multiple trocar ports 10, having thesame or different cross-sectional shapes and/or areas, may be placed inthe patient 14. The tissue 12 may be the chest wall of the patient 14,thereby providing access to the thoracic cavity. However, the tissue 12may be the abdominal wall or any other suitable tissue in the patient14. Alternately, the trocar port or ports 10 are not used, and access tothe surgical site is gained in another manner, such as described above.

Referring also to FIGS. 1 and 9, the user of the endocutter 2, a medicalprofessional such as a surgeon, receives and possesses the endocutter 2.“Receiving” the endocutter 2 means that the user takes the endocutter 2in hand, either directly from out of its package, or indirectly via anurse, medical technician or other person. The end effector 4 of theendocutter 2 may be introduced into the patient 14 through one of thetrocar ports 10. Referring to FIG. 9, the end effector 4 may be insertedinto the patient 14 in a closed configuration. At least part of theshaft 6 of the endocutter 2 may follow the end effector 4 into thepatient 14. Alternately, the trocar port or ports 10 are not used, andthe endocutter 2 is used during a conventional open surgical procedureor is introduced into the patient 14 directly through an incision intissue 12. The end effector 4 is positioned by the user at a surgicalsite. As one example, referring also to FIG. 26, a surgical site islocated on a blood vessel 148 which is to be transected. For clarity,this document describes the operation of the endocutter 2 fortransection of a blood vessel 148. However, the use of the endocutter 2is not limited to blood vessel transection; the endocutter 2 may be usedto perform any other suitable procedure at any other surgical site inthe body. For example, the endocutter 2 may be used to transect a bileduct, to remove a diseased appendix, to transect gastrointestinaltissue, to remove a diseased lobe of a lung or liver, and/or to transectsoft tissue or organs.

As set forth in the Endocutter Document, at least the distal end of theanvil 32 is initially spaced apart from the staple holder 30, such thatthe end effector 4 is open. The end effector 4 is advanced over theblood vessel 148 to be transected, until the entire diameter of theblood vessel 148 is located between the anvil 32 and the staple holder30. Advantageously, the blood vessel 148 is substantially at a rightangle to the anvil 32 and the staple holder 30. However, the bloodvessel 148 may be oriented at any other suitable angle relative to theanvil 32 and the staple holder 30. The end effector 4 is then closed, bymoving the anvil 32 closer to the staple holder 30, such that the bloodvessel 148 is compressed between the anvil 32 and the staple holder 30.Such closure of the end effector 4 may be accomplished as set forth inthe Endocutter Document. Closure of the end effector 4 may be performedby actuating one or more controls on the handle 8 of the endocutter 2,and/or by releasing energy stored in the handle 8. After the endeffector 4 has been closed, the tissue to be treated is held securelyby, and affirmatively controlled by, the end effector 4.

Referring to FIGS. 18 and 20, the active wedge 71 is in an initialposition, in a first configuration. The initial position of the activewedge 71 in the staple holder 30 is proximal to the apertures 62therein, and proximal to the staples 18 to be deployed. In the firstposition, the knife 124 may extend through the knife slot 64, such thatpart of the sharp edge 126 is located above the knife slot 64 and partof the sharp edge 126 is located below the knife slot 64; advantageouslythe sharp edge 126 is located proximal to tissue 148 and does notcontact tissue 148 in the first position. The “first configuration”refers to a position of each wedge grate 110 relative to the wedge base70. The first configuration also may be referred to as the “wedge down”configuration. In the first configuration, the entirety of the wedgegrate 110 is positioned below the upper surface 74 of the wedge base 70.Also in the first configuration, the cross pin 114 of each wedge grate110 is positioned proximal to the peak 132 of the proximal wedge catch130. Further, the cross pin 114 of each wedge grate 110 may bepositioned at the proximal end of a corresponding channel 48 defined inthe bottom inner surface 49 of the staple holder 30. Advantageously,referring also to FIG. 10, at least one cross pin 114 rests on at leastone step 50 defined in a channel 48. In this way, the cross pin 114 maybe vertically spaced above the bottom inner surface 49 of the stapleholder 30. Alternately, at least one cross pin 114 may slide along thebottom of a corresponding channel 48. Advantageously, when the activewedge 71 is in the first position and the first configuration, the crosspin 114 is held between the peak 132 of the proximal wedge catch 130 anda proximal wall 140 of the corresponding channel 48, where the proximalwall 140 extends inward from the outermost portion of thelaterally-outermost step 50 and thereby prevents proximal motion of thecross pin 114 beyond that proximal wall 140. Referring also to FIGS. 13and 16A, in the first configuration, each pin 122 extending from acorresponding wedge plate 112 may be positioned at the distal end 84 ofthe corresponding channel 82 defined in a bulkhead 72 of the wedge base70. Further, referring also to FIG. 22, an upper channel surface 142 isspaced vertically from the bottom inner surface 49 of the staple holder30, and prevents the cross pin 114 from moving substantially upward.That is, aside from a small amount of play to allow the cross pin 114 toslide longitudinally, the cross pin 114 is vertically constrainedbetween the upper channel surface 142 and the step 50.

The user then actuates one or more controls on the handle 8 to actuatethe end effector 4. As a result, the actuation band 100 is moveddistally, by any suitable mechanism or method. As one example, theproximal end of the actuation band 100 may extend near to or into thehandle 8, and a mechanism within the handle 8 urges the actuation band100 distally. The mechanism may be actuated by a release of energystored within the handle 8. A mechanism for moving a actuation band 100linearly is standard; any suitable mechanism or mechanisms may beutilized. Distal motion of the actuation band 100 in turn urges theactive wedge 71 distally, due to the attachment between the actuationband 100 and the boss 90.

As the active wedge 71 is urged distally, each cross pin 114 of a wedgegrate 110 is urged distally as well. However, each peak 132 of theproximal wedge catch 130 resists the distal motion of the correspondingcross pin 114, because each peak 132 is distal to and in the path of thecross pin 114, which in turn is constrained to move substantiallylongitudinally and not vertically. Consequently, each cross pin 114 doesnot immediately ride up over the corresponding peak 132, but rather ispushed longitudinally against the proximal wedge catch 130, which actsagainst the distal force applied to the active wedge 71. As a result,each cross pin 114 is held in place while the wedge base 70 advancesdistally. This relative motion between the cross pin 114 and the wedgebase 70 urges each pin 122 extending from a corresponding wedge plate112 out of the distal end of the corresponding channel 82 in the wedgebase 70, referring also to FIG. 13. Each pin 122 then slides up thecentral segment 86 of the channel 82, until that pin 122 is caught byand stops in the detent 88 in the channel 82. As a result of this motionof the pins 122, the wedge plate 112 and thus the wedge grate 110 as awhole moves upward relative to the wedge base 70 to the secondconfiguration.

Referring to FIGS. 21-22, the “second configuration” means that at leastpart of at least one wedge plate 112 is positioned above the uppersurface 74 of the wedge base 70. The second configuration may bereferred to as the “wedge up” configuration as well. Advantageously, inthe second configuration, at least part of the separation surface 120 ofeach wedge plate 112 is positioned above the upper surface 74 of thewedge base 70. The wedge base 70 is still substantially positioned atthe initial position, and each cross pin 114 is still located betweenthe corresponding peak 132 of the proximal wedge catch 130 and theproximal wall 140 of the corresponding channel 48. The actuation band100 continues to apply a force in the distal direction to the activewedge 71. Because the wedge grate 110 can no longer move relative to thewedge base 70, that distal force applied to the active wedge 71 causeseach crossbar 114 to push the proximal end of the proximal wedge catch130 downward. This may be facilitated by a distally-sloped upward bendor angle in the proximal wedge catch 130 proximal to each peak. That is,the force applied to the proximal wedge catch 130 by the active wedge 71grows large enough to push the proximal wedge catch 130 out of the pathof motion of the wedge grate 110.

At that time, the active wedge 71 is free to move distally, slidinglongitudinally along the channels 48 defined in the bottom inner surface49 of the staple holder 30. Distal motion of the active wedge 71 causesdeployment of the staples 18. For clarity, motion of a single wedgeplate 112 to deploy one or more staples 18 in a corresponding row 26 isdescribed.

Referring also to FIGS. 3-5 and 6-8, the active wedge 71 is initiallyproximal to the staples 18 in the corresponding generally-linear row 26,and the path of motion of each wedge plate 112 may be generally parallelto or collinear with the corresponding row 26. Referring also to FIGS.16-17, as the wedge plate 112 moves distally, the encounter surface 116of the wedge plate 112 contacts the most-proximal staple 18 in thecorresponding row. Contact between the encounter surface 116 and thestaple 18 applies force to the staple 18. Because the encounter surface116 is substantially vertical, that force applied to the staple 18 isexerted in substantially a distal, longitudinal direction substantiallynormal to the encounter surface 116. This force is applied to the leg 20or portion of the smooth curve of the staple 18 that is located closerto the tab 28 than to the free end 22. As a result, the distal forceapplied to the staple 18 results in a moment about the tab 28 or otherfrangible connection that connects the staple 18 to the feeder belt 16.The moment acts on the staple 18 to rotate the staple 18 about the tab28, such that the free end 22 of the staple 18 moves upward, out of thecorresponding aperture 62 in the upper surface 60 of the staple holder30 and into the blood vessel 148 or other tissue clamped between theanvil 32 and the staple holder 30. During motion of the active wedge 71,the feeder belt 16 may be held substantially in place.

Referring also to FIGS. 27-29, as the active wedge 71 moves, itencounters the peak 208 of the arm 204 of the staple trap 200 closest tothe most-proximal staple 18. As the active wedge 71 slides distally, itexerts a force on the arm 204, because at least the peak 208 of the arm204 is in the path of the active wedge 71. Because the arm 204 iscurved, that curvature allows the active wedge 71 to deflect the arm 204laterally sideways. The arm 204 begins to deflect laterally away fromits neutral position. When the active wedge 71 has moved to a positionin which the peak 208 of the arm 204 is in contact with the lateral sideof the active wedge 71, the arm 204 has reached its position of maximumlateral deflection, as seen in FIG. 40, and will remain in that positionof maximum lateral deflection as long as the peak 208 contacts thelateral side of the active wedge 71. In this position of the arm 204,the arm 204 has been moved out of the corresponding staple 18 such thatthe staple 18 is free to be deformed and separated as described ingreater detail below. Alternately, where the staple 18 has alreadydeflected the corresponding arm 204 out of the neutral position bycontact between the staple 18 and the arm 204, the active wedge 71 may,but need not, contact the arm 204 during its approach to the staple 18.

The active wedge 71 continues to slide distally, such that the encountersurface 116 of the wedge plate 112 exerts a force on the staple 18 thatcauses a moment about the tab 28. As the staple 18 rotates about the tab28, and the wedge plate 112 continues to move distally, the lowest pointof the staple 18 moves upward. When the lowest point of the staple 18moves above the encounter surface 116, the deformation surface 118begins to contact the staple 18. The deformation surface 118 is angledand/or curved upward in the proximal direction such that contact betweenthat deformation surface 118 and the staple 18 continues to cause amoment about the tab 28 such that the staple 18 continues to rotateupward about the tab 28. As the free end 22 of the staple 18 rotatesupward, it penetrates completely through the blood vessel 148 and thencontacts the lower surface of the anvil 32. Optionally, a standardstaple bending feature may be defined in the anvil 32 at the locationwhere the free end 22 of the staple 18 contacts the anvil 32. As thefree end 22 of the staple 18 contacts the anvil 32, the rotation of thestaple 18 about the tab 28 results in motion of the free end 2 bothupward and distally. However, contact between the free end 22 of thestaple 18 and the anvil 32 prevents further upward motion of the freeend 22 of the staple 18. As a result, the free end 22 of the staple 18moves distally along the lower surface of the anvil 32 and/or staplebending feature defined thereon. This motion may bend or deform the leg20 of the staple 18 associated with the free end 22, closing the staple18 to form a D-shape or other suitable shape. The staple 18 may befabricated from a plastically-deformable material such as stainlesssteel, such that deformation of the staple 18 may be plasticdeformation. Alternately, at least part of at least one staple 18 may beelastically deformable or superelastically deformable.

As the active wedge 71 continues to move distally, the separationsurface 120 of the wedge plate 112 slides distally toward the tab 28. Asseen in FIG. 22, the top of the separation surface 120 extends above theupper surface 74 of the wedge base 70, and may extend above the uppersurface of the feeder belt 16. As the separation surface 120 contactsthe tab 28 during the longitudinal travel of the active wedge 71, itapplies a force to the tab 28. As a result of the rotation of the staple18 at its point of connection to the feeder belt 16, that connection mayhave experienced work hardening and become more brittle. As theseparation surface 120 of the wedge plate 112 contacts and applies forceto the tab 28, the that force applied by the separation surface 120breaks or shears the staple 18 from the feeder belt 16 at the tab 28.Where the staple 18 and/or tab 28 include a weakened area at or neartheir intersection, the staple 18 may shear, break or otherwise separatefrom the feeder belt 16 at that weakened area. The separation surface120 may be shaped to also actively push, urge or otherwise eject thestaple 18 completely out of the staple holder 30. Alternately, thestaple 18 is passively ejected from the staple holder 30, meaning thatthe staple 18 is not affirmatively urged out of the staple holder 30;rather, it is simply released from the staple holder 30 and allowed toexit therefrom. At this point, the deformed and ejected staple 18 is inposition in the blood vessel 148. The frangibility of the staples 18allows the staples 18 to be held securely and reliably by the feederbelt 16, and thus by the staple holder 30, while providing for reliableseparation and deployment.

After the staple 18 has been separated from the feeder belt 16, theactive wedge 71 continues its motion in the distal direction. As it doesso, the active wedge 71 moves distal to the peak 208 of the arm 204 ithad previously deflected laterally. Such motion of the active wedge 71allows the arm 204 to return to its neutral position, directlyunderneath a corresponding aperture 64 in the staple holder 30.Advantageously, the arm 204 is a leaf spring, or acts as a leaf spring,that is biased toward the neutral position. When in the neutralposition, at least a portion of the arm 204 is located directlyunderneath a corresponding aperture 64 in the staple holder 30. In thisposition, the arm 204 blocks the deformed and separated staples 18 fromfalling back into the cavity 212 through the aperture 64. Instead, wherea staple or staples 18 are deployed into air rather than into tissue,those closed, separated staples 18 simply remain harmlessly in the bodyrather than reentering the cavity 212 in the staple holder 30.Optionally, where the wedge moves in the opposite direction, distal toproximal, the staple trap 200 may be simply reversed in the stapleholder 30, and the operation of the tool is substantially as describedabove, with the directions reversed. Such a wedge is described in U.S.patent application Ser. No. 12/436,101 filed on May 5, 2009, which isherein incorporated by reference in its entirety. Although the stapletrap 200 has been described here in conjunction with an active wedge 71,a conventional single-piece wedge could be utilized with the staple trap200 instead, if desired.

As the active wedge 71 continues its motion in the distal direction, itencounters another staple 18, and deforms that staple 18 and separatesthat staple 18 from the feeder belt 16 in substantially the same manneras described above. The wedge grate 110 may be long enough that, as thewedge grate 110 has deformed one staple 18 a substantial amount but thatstaple 18 has not yet separated from the feeder belt 16, the wedge grate110 engages and begins to deform the next most distal staple 18.Alternately, the wedge grate 110 is short enough that it completelydeforms one staple 18, which is then ejected, before the wedge grate 110engages and begins to deform the next most proximal staple 18. As theactive wedge 71 moves distally, the knife 124 also slides distally alongthe knife slot 64, such that the sharp edge 126 of the knife 124 cutsthe tissue held between the anvil 32 and staple holder 30. The knife 124cuts tissue as the staples 18 are being deformed and ejected.Optionally, where the I-beam head 128 is fixed to the knife 124, thatI-beam head 128 slides along a corresponding channel in the anvil 32,such that clamping is reinforced at or near the location of stapling asthe active wedge 72 slides distally.

Referring to FIG. 23, the active wedge 71 may continue to move distallyuntil the cross pin 114 of each wedge grate 110 encounters the distalwall 144 of the corresponding channel 48. Contact between each cross pin114 and the corresponding distal wall 144 prevents further distal motionof the cross pin 114, and thus prevents further distal motion of theactive wedge 71. Because the pins 122 of the wedge plates 112 arealready in the corresponding detents 88 in the channels 82 in the wedgebase 70, the wedge grate 110 cannot move further proximally relative tothe wedge base 70 as a result of contact between the wedge grate 110 andthe distal wall 144. This position of the active wedge 71 may bereferred to as the second, final position, and the wedge grate 110 isstill in the second configuration.

The endocutter 2 may then be reset for another firing. To do so, theactuation band 100 is retracted proximally such as by actuating one ormore controls on the handle 8. As the band 100 moves proximally, itexerts a force in the proximal direction on the active wedge 71 and thewedge grate 110. When each cross pin 114 reaches the distal wall 144,the cross pin 114 may have already moved distally to the distal wedgecatch 134, referring also to FIG. 24. The distal wedge catch 134 mayinclude a portion proximal to its peak 136 that slopes gently upward inthe distal direction, so that each cross pin 114 can push down thedistal wedge catch 134 and slide over the peak 136 as it moves distally;after the cross pin 114 has moved distally to the peak 136, the peak 136springs back upward. Thus, in the final position of the active wedge 71,each cross pin 114 may be held between the distal wall 144 and a peak136 of the distal wedge catch 134. As the active wedge 71 is urgedproximally, each cross pin 114 of a wedge grate 110 is urged proximallyas well. However, each peak 136 of the distal wedge catch 134 resiststhe proximal motion of the corresponding cross pin 114, because eachpeak 136 is proximal to and in the path of the cross pin 114, which inturn is constrained to move substantially longitudinally and notvertically, as set forth above. Consequently, each cross pin 114 doesnot ride up over the corresponding peak 136 but rather is pulledlongitudinally against the distal wedge catch 134, which acts againstthe distal force applied to the active wedge 71. As a result, each crosspin 114 is held in place while the wedge base 70 moves proximally. Thisrelative motion between the cross pin 114 and the wedge base 70 urgeseach pin 122 extending from a corresponding wedge plate 112 distally outof the detent 88 in the corresponding channel in the wedge base 70,referring also to FIG. 13. Each pin then slides down the central segment86 of the corresponding channel 82, until that pin 122 is caught by andstops in the distal end 84 of the corresponding channel 82. As a resultof this motion of the pins 122, the wedge plates 112 and thus the wedgegrate 110 as a whole moves downward relative to the wedge base 70 to thefirst configuration, as seen in FIG. 25. In the first, wedge-downconfiguration, each wedge grate 110 is below the upper surface 74 of thewedge base 70, such that the wedge grate 110 does not contact orotherwise engage the feeder belt 16 during motion of the wedge base 70proximally.

Optionally, where the wedge base 70 includes one or more return arms 94,the return arms 94 may act to advance each feeder belt 16. The tooth 96may be biased against the lower portion of the feeder belt 16. Duringadvancement of the active wedge 71, the tooth 96 sequentially engagesapertures 51 in the corresponding feeder belt 16, but due to the angleddistal surface 99 of the tooth 96, the tooth 96 slides out of eachaperture 51 as the angled distal surface 99 slides against the distaledge of each aperture 51, causing the cantilevered return arm 94 to flexupward. In this way, the return arms 94 do not cause motion of thefeeder belts 16 during deployment of staples 18. However, as the wedgebase 70 moves distally, the tooth 96 of each return arm 94 slides intoan aperture 51 in the feeder belt 16 if those teeth 96 are not alreadylocated in apertures 51. As the wedge base 70 moves distally, thesubstantially vertical planar face 98 at the proximal end of each tooth96 encounters the proximal end of the corresponding aperture 51. Becausethe face 98 is substantially vertical, and not angled to allow the tooth96 to slip out, the face 98 engages the aperture 51, pushing the feederbelt 16 via the proximal edge of the corresponding aperture 51. Eachfeeder belt 16 is routed around a reversal wheel 42, along a path thatstarts generally straight and in the distal direction, then is curveddownward along the surface of the corresponding reversal wheel 42, andthen is generally straight and in the proximal direction, such that thereversal wheel 42 changes the direction of motion of the correspondingfeeder belt 16 from generally distal to generally proximal. The portionof the feeder belt 16 located under and proximal to the reversal wheel42 may be retracted proximally, thereby pulling the portion of thefeeder belt 16 located above and proximal to the reversal wheel 42 inthe distal direction and advancing fresh staples 18 into the housing 60.As the bottom portion of the feeder belt 16 is moved proximally by thereturn arm 94, the upper portion of the feeder belt 16 moves distally;this reversal of motion is caused by the wrapping of the feeder belts 16about substantially half a circumference of the reversal wheels 42, asseen in FIGS. 10-11. Thus, as the wedge base 70 slides proximally backto its initial position, the return arms 94 cause the feeder belt 16 toadvance a fresh set of unfired staples 18 into place within the stapleholder 30. The motion of the feeder belt 16 that advances fresh staples18 into position for firing may be referred to as “advancing” the feederbelt 16, regardless of the fact that part of the feeder belt 16 may bemoved in a direction other than distally during that advancing.

As the active wedge 71 is urged proximally by proximal motion of theactuation band 100, each cross pin 114 of a wedge grate 110 is urgeddistally as well. However, each peak 136 of the distal wedge catch 134resists the proximal motion of the corresponding cross pin 114, becauseeach peak 136 is proximal to and in the path of the cross pin 114, whichin turn is constrained to move substantially longitudinally and notvertically. Consequently, each cross pin 114 does not immediately rideup over the corresponding peak 134, but rather is pulled longitudinallyagainst the distal wedge catch 134, which acts against the proximalforce applied to the active wedge 71. As a result, each cross pin 114 isheld in place while the wedge base 70 withdraws proximally. Thisrelative motion between the cross pin 114 and the wedge base 70 urgeseach pin 122 extending from a corresponding wedge plate 112 out of thedetent 88 at the proximal end of the corresponding channel 82 in thewedge base 70, referring also to FIG. 13. Each pin 122 then slides downthe central segment 86 of the channel 82, until that pin 122 is caughtby and stops at the distal end 84 of the channel 82. As a result of thismotion of the pins 122, the wedge plate 112 and thus the wedge grate 110as a whole moves downward relative to the wedge base 70 to the first,wedge-down configuration.

As set forth above, in the first, wedge-down configuration, each wedgeplate 112 is positioned substantially below the upper surface 74 of thewedge base 70. The wedge base 70 is still substantially positioned atthe final position, and each cross pin 114 is still located between thecorresponding peak 136 of the distal wedge catch 134 and the distal wall144 of the corresponding channel 48. The actuation band 100 continues toapply a force in the proximal direction to the active wedge 71. Becausethe wedge grate 110 can no longer move relative to the wedge base 70,that proximal force applied to the active wedge 71 causes each crossbar114 to push the distal wedge catch 134 downward. This may be facilitatedby a distally-sloped downward bend or angle in the distal wedge catch134 distal to each peak. That is, the force applied to the distal wedgecatch 134 by the active wedge 71 grows large enough to push the distalwedge catch 134 out of the path of motion of the wedge grate 110.

The active wedge 71 is then moved proximally until each cross pin 114 ofthe active wedge 71 reaches the proximal wall 140 of each channel 48 inthe bottom inner surface 49 of the staple holder 30. Before it does so,each cross pin 114 may slide past the proximal wedge catch 130. Theproximal wedge catch 130 may include a portion distal to its peak 136that slopes gently upward in the proximal direction, so that each crosspin 114 can push down the proximal wedge catch 130 and slide over thepeak 132 as it moves proximally; after the cross pin 114 has movedproximal to the peak 132, the peak 132 springs back upward.

Next, the end effector 4 may be actuated again at the option of theuser, substantially as described above. In this way, the end effector 4may be actuated multiple times without removing the end effector 4through the trocar port 10 or other incision, structure or mechanismthat allows access to the interior of the body of the patient. Keepingthe end effector 4 within the body of the patient without withdrawingthat end effector 4 through the trocar port 10 or other incision,structure or mechanism that allows access to the interior of the body ofthe patient may be referred to as maintaining the end effector withinthe body of the patient. The endocutter 2 may be actuated multiple timeswithin the patient, without being removed from the patient, until thestaples 18 in the endocutter 2 are exhausted. An indicator may beprovided in the handle 8 or at another location in the endocutter 2 thatshows how many unfired staples 18 remain in the endocutter 2.

Actuation of the endocutter 2 above has been generally described interms of deployment and ejection of a single row 26 of staples 18 forclarity, where that deployment and ejection may be performed insubstantially the same manner along each row 26 of staples 18. Operationof the endocutter 2 may be substantially as described above with regardto any number of rows 26 of staples 18 on a feeder belt 16, or anynumber of feeder belts 16. Further, operation of the endocutter 2 may beperformed during testing, in which case the possessing of the endocutter2 may be performed by a human or by a machine. During testing, thetissue utilized may be artificial or simulated, and actuation of theendocutter 2 is performed as if that were actual tissue.

While the invention has been described in detail, it will be apparent toone skilled in the art that various changes and modifications can bemade and equivalents employed, without departing from the presentinvention. It is to be understood that the invention is not limited tothe details of construction, the arrangements of components, and/or themethod set forth in the above description or illustrated in thedrawings. Statements in the abstract of this document, and any summarystatements in this document, are merely exemplary; they are not, andcannot be interpreted as, limiting the scope of the claims. Further, thefigures are merely exemplary and not limiting. Topical headings andsubheadings are for the convenience of the reader only. They should notand cannot be construed to have any substantive significance, meaning orinterpretation, and should not and cannot be deemed to indicate that allof the information relating to any particular topic is to be found underor limited to any particular heading or subheading. Therefore, theinvention is not to be restricted or limited except in accordance withthe following claims and their legal equivalents.

What is claimed is:
 1. A surgical stapler, comprising: a staple holderincluding a cavity defined therein, a plurality of staples held withinsaid cavity; an upper surface; a plurality of apertures defined throughsaid upper surface through which said staples are deployable, at leastone wedge movable within said cavity, and at least one staple trapincluding a strip and a plurality of arms extending from and bentrelative to said strip, wherein at least one said arm resides in aneutral position directly underneath a corresponding said aperture suchthat said at least one arm blocks at least one of said staples frommoving through said corresponding aperture, and wherein articulation ofsaid wedge moves said at least one arm away from the neutral position toallow for release of said at least one staple.
 2. The surgical apparatusof claim 1, wherein at least one said strip is oriented substantiallylongitudinally within said staple holder.
 3. The surgical apparatus ofclaim 1, wherein at least one said strip is oriented substantiallyparallel to the direction at least one corresponding said wedge slideswithin said cavity.
 4. The surgical apparatus of claim 1, wherein atleast one said arm is generally rectangular.
 5. The surgical apparatusof claim 1, wherein at least one said arm is generally trapezoidal. 6.The surgical apparatus of claim 1, wherein at least one said armgenerally forms a parallelogram.
 7. The surgical apparatus of claim 1,wherein at least one said wedge is an active wedge.
 8. The surgicalapparatus of claim 1, wherein said wedge deflects said arms laterallyaway from the neutral position as it slides within said cavity, whereinsaid deflection sequentially moves said arms laterally away from theneutral position to a position no longer directly underneath acorresponding said aperture.
 9. The surgical apparatus of claim 8,wherein continued motion of said wedge sequentially allows said arms toreturn to their neutral position.
 10. The surgical stapler of claim 1,further comprising an end effector, wherein said staple holder is acartridge detachable from said end effector.
 11. The surgical stapler ofclaim 1, further comprising an end effector, wherein said staple holderis fixed to and nondetachable from said end effector.
 12. The surgicalstapler of claim 1, wherein said wedge is movable by slidingsubstantially longitudinally.
 13. A surgical stapler, comprising: astaple holder including a cavity defined therein, a feeder beltextending into said cavity, a plurality of staples within said cavity,said staples affixed to and frangibly separable from said feeder belt,an upper surface; a plurality of apertures defined through said uppersurface through which said staples are deployable, at least one wedgelongitudinally movable within said cavity, and at least one staple trapincluding a strip and a plurality of arms extending from and bentrelative to said strip, wherein at least one said arm resides in aneutral position directly underneath a corresponding said aperture suchthat said at least one arm blocks at least one of said staples frommoving through said corresponding aperture, and wherein articulation ofsaid wedge moves said at least one arm away from the neutral position toallow for release of said at least one staple.
 14. The surgicalapparatus of claim 13, wherein at least one said wedge is an activewedge.
 15. The surgical apparatus of claim 13, wherein a plurality ofsaid staples are arranged in a longitudinal row along a correspondingsaid feeder belt, wherein said wedge is longitudinally moveable tosequentially both deflect said arms laterally and deploy said staples.16. The surgical apparatus of claim 15, wherein said wedge islongitudinally movable in a distal direction from an initial location.17. The surgical apparatus of claim 13, wherein said arms are leafsprings.